Varicose veins: what can be done to help?

In this blog for non-medical readers, Lynda Ware, a Senior Fellow in General Practice at Cochrane UK, looks at the latest Cochrane evidence on the treatment of varicose veins.

Take home points

Varicose veins, which appear as purple/blue swellings just under the skin, are common • Lifestyle changes may help relieve symptoms. For example, losing weight, being more active, sitting and standing less • Mild symptoms may be treated with compression stockings • Surgical interventions are available when there are severe complications such as bleeding or ulceration (the development of ulcers). It is unclear which treatment is best

Varicose veins are common and at least 1 in 3 of us will develop them. They can occur at several sites in the body but are commonest in the legs and these are what this blog will focus on.

Varicose veins appear as purplish/blue knobbly swellings just under the skin. Normally, blood flows from the veins on the outside of the legs to the deep veins and then back to the heart. The direction of flow is regulated by one-way valves, which, if damaged or weakened, allow blood to pool in the thin-walled superficial veins which swell and form varicose veins (or ‘varicosities’). The term venous insufficiency refers to this condition, where blood does not flow back properly to the heart.

Certain conditions put us at greater risk of developing varicose veins. For example:

  • Being older
  • Being female
  • Having a family history of varicose veins
  • Pregnancy
  • Obesity
  • Prolonged sitting or standing
  • A history of deep vein thrombosis (a blood clot in a vein)

Varicose veins are unsightly and can cause embarrassment and distress because of their appearance. People may also complain of muscle aching and cramps; burning and itching of the overlying skin; swollen feet and ankles. Sometimes there are more serious complications such as bleeding, skin ulceration, superficial and deep vein thrombosis.

What can be done to help?

Prevention

Unfortunately, there isn’t much we can do to stop varicose veins developing or from getting worse. Keeping active and maintaining a healthy weight are sensible lifestyle choices.

Symptomatic relief

Regular exercise helps improve circulation. It is important to avoid sitting or standing for long periods of time since this will make symptoms worse. Raising your legs on a pillow when resting can bring relief.

Compression hosiery is often prescribed. This can be in the form of knee-length socks, stockings, or tights, which compress the lower limbs in a graduated fashion to encourage the flow of venous blood away from the outside of the legs and back to the heart.

Surgical treatments

Where symptoms are life-affecting or where there are serious complications such as recurrent or persistent leg ulceration, a surgical procedure may be recommended. The commonest treatments are:

  • Endothermal ablation in which the affected veins are sealed using energy from high-frequency radio waves or lasers
  • Ultrasound-guided foam sclerotherapy to seal off the affected veins
  • Ligation and stripping where affected veins are removed surgically

What does Cochrane evidence tell us about treating varicose veins?

Five reviews have been published in the Cochrane Library in 2021 looking at the treatment of varicose veins. One looks at the role of compression stockings as a first treatment, and the other four consider surgical procedures.

How effective and safe are compression stockings for treating varicose veins?

This is what the Cochrane Review Graduated compression stockings for the initial treatment of varicose veins in people without venous ulceration (July 2021) hoped to find out.

Thirteen studies were included in this review, with 1021 people, all of whom had varicose veins but no active skin ulceration. Disappointingly, there was insufficient evidence to be able to draw firm conclusions on how effective and safe compression stockings are since many of the studies looked at different outcomes and used different ways to assess and report them. Further well-designed trials are needed to help answer this question.

Which treatments for varicose veins are the most effective?

The Cochrane Review Interventions for great saphenous vein incompetence (August 2021) looked at this.

The authors found data on well-established procedures such as radiofrequency and laser ablation, foam sclerotherapy and surgery. They also included findings from studies looking at newer treatments such as cyanoacrylate glue, mechanochemical ablation and endovenous steam ablation.

There are relatively few studies and the evidence remains uncertain as to which procedure is best. However, it appears that all currently available treatments may be similar in terms of how well they destroy the veins and stop blood pooling in the legs.

Surgical treatments for varicose veins

The review Surgery for deep venous insufficiency (September 2021) looked at studies investigating surgical treatments of deep venous insufficiency. The authors found only four small studies, all of which considered surgical repair of venous valves (valvuloplasty). The evidence was of low- or very low-certainty and no firm conclusions could be drawn on the effectiveness and safety of the procedure.

Another review, CHIVA method for the treatment of chronic venous insufficiency (September 2021) looked at a specific minimally-invasive surgical technique for treating varicose veins. There were six studies included in the review, with 1160 people. CHIVA was compared to vein stripping, compression stockings, radiofrequency ablation and endovenous laser therapy. The certainty of the evidence was low or very low and further studies are needed before firm conclusions can be drawn.

The updated review Injection sclerotherapy for varicose veins (December 2021) looked at the effectiveness and safety of sclerotherapy. There were 28 studies included in the review, involving 4278 participants. The authors concluded that low to very low certainty evidence indicates that sclerotherapy may be effective but that rates of deep vein thrombosis may be slightly increased. It is uncertain whether any particular foam or technique is superior to any other.

You can find further information about the treatment of varicose veins on the NHS website.


Join in the conversation on Twitter with and @CochraneUK and @CochraneVasc or leave a comment on the blog. 

Please note, we cannot give specific medical advice and do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion but we ask that comments are respectful and reserve the right to not publish any we consider offensive. Cochrane UK does not fact check – or endorse – readers’ comments, including any treatments mentioned.

References (pdf)

Lynda Ware has nothing to disclose.



Varicose veins: what can be done to help? by Lynda Ware

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

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